Wang Boyan, Zhou Yongjie, Jia Min, Yan Zhiping, Chen Jiayan, Lu Xueguan, Wu Ruiyan, Wen Junmiao
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Surg. 2021 Mar 9;8:649802. doi: 10.3389/fsurg.2021.649802. eCollection 2021.
According to the lung cancer staging project, T2b (>5-7 cm) and T3 (>7 cm) non-small cell lung cancers (NSCLC) should be reclassified into T3 and T4 groups. The objective of this study was to evaluate the effect of surgery alone or surgery plus adjuvant radiation (SART) on survival of node-negative patients with NSCLC >5 cm. We identified 4557 N0 patients with NSCLC >5 cm in the Surveillance, Epidemiology, and End Results database from 2004 to 2014. Overall survival (OS) and cancer-specific survival (CSS) were compared among patients who underwent surgery alone and SART. The proportional hazards model was applied to evaluate multiple prognostic factors. 1,042 and 525 patients who underwent surgery alone and SART, respectively were enrolled after propensity-score matching. OS and CSS favored surgery alone rather than SART. Multivariate analysis showed that the number of lymph nodes examined more than six was associated with better OS and CSS for NSCLC >5 cm, especially in patients treated with surgery alone. Lobectomy should be recommended as the primary option for NSCLC >5 to 7 cm, whereas its superiority was not significant over sublobectomy for NSCLC >7 cm. Surgery alone should be recommended as the first choice for patients with NSCLC >5 cm. The number of examined lymph nodes should be more than six in patients with NSCLC >5 cm, especially for those who undergo surgery alone. For patients with NSCLC >7 cm who could not tolerate lobectomy, sublobectomy might be an alternative surgical procedure.
根据肺癌分期项目，T2b（>5 - 7厘米）和T3（>7厘米）的非小细胞肺癌（NSCLC）应重新分类为T3和T4组。本研究的目的是评估单纯手术或手术加辅助放疗（SART）对肿瘤直径>5厘米的NSCLC淋巴结阴性患者生存的影响。我们在2004年至2014年的监测、流行病学和最终结果数据库中确定了4557例肿瘤直径>5厘米的NSCLC N0患者。比较了接受单纯手术和SART的患者的总生存期（OS）和癌症特异性生存期（CSS）。应用比例风险模型评估多个预后因素。倾向得分匹配后，分别纳入了1042例接受单纯手术和525例接受SART的患者。OS和CSS支持单纯手术而非SART。多变量分析表明，检查的淋巴结数量超过6个与肿瘤直径>5厘米的NSCLC的更好的OS和CSS相关，尤其是在接受单纯手术治疗的患者中。对于肿瘤直径>5至7厘米的NSCLC，应推荐肺叶切除术作为主要选择，而对于肿瘤直径>7厘米的NSCLC，其相对于肺段切除术的优越性并不显著。对于肿瘤直径>5厘米的NSCLC患者，应推荐单纯手术作为首选。对于肿瘤直径>5厘米的NSCLC患者，尤其是接受单纯手术的患者，检查的淋巴结数量应超过6个。对于无法耐受肺叶切除术的肿瘤直径>7厘米的NSCLC患者，肺段切除术可能是一种替代手术方法。
